In fact, the newspaper suggests that the VA may actually attract troubled doctors and clinicians because it doesn’t require that they have their own malpractice insurance. Thus, doctors dubbed too risky for private malpractice insurance based on problematic pasts may find relief at the VA, where malpractice claims are paid out using taxpayer money.

In their investigation, USA Today dug up 15 prior malpractice complaints and settlements against neurosurgeon John Henry Schneider, who was hired in April by the Veterans Affairs hospital in Iowa City, Iowa, with an annual salary of $385,000.

The malpractice cases stretch back to 1997, just months after Dr. Schneider received his medical license in Montana. Lawsuits and complaints allege that Schneider’s surgeries left one patient paralyzed, another with severe brain damage, and several with botched spine operations and severe pain. One patient lost bladder and bowel control after Schneider performed three spine surgeries.

In 2014, the Wyoming Board of Medicine revoked Schneider’s license following a wrongful death suit filed by the family of one of his former patients. In that case from 2011, Russell Monaco, a father of two, had surgery to reduce pressure on nerves in his lower back. Afterward, he was discharged—despite dangerously low blood-oxygen levels—and prescribed a lethal mix of narcotics, including fentanyl, oxycodone, valium, and Demerol. He took the medications as prescribed and died at home the next day, devastating and traumatizing his family, the lawsuit alleges.

“I tried to wake him up and yelled and the girls came down screaming,” his wife, Kathy Monaco told USA Today. “It was horrible, I mean, I live that day over every day.”

Still, Schneider held a medical license from Montana and continued to practice. Later in 2014, he filed for bankruptcy, leaving malpractice payouts in limbo, including payments to the Monaco family.

Getting by

In an interview with the paper, Dr. Schneider denies any wrongdoing and blames colleagues or uncontrollable medical complications.

In a statement, the VA said that Schneider had disclosed “all the issues” in his job application and was hired after a “group of his medical peers thoroughly reviewed” his file and “approved his competency.”

In light of USA Today’s investigation, though, VA officials determined that Schneider’s hiring was illegal. Agency spokesperson Curt Cashour said that agency officials provided the Iowa City hospital with “incorrect guidance” about Schneider’s hiring. The VA moved to fire Schneider last Wednesday, but he resigned ahead of time.

Schneider isn’t the only questionable hire from the VA, the investigation found. Reporters dug up a string of others. Those include the hiring of psychiatrist Stephen Lester Greer in 2013 to a VA hospital in Muskogee, Oklahoma, despite the state’s board taking several disciplinary actions against Greer previously. One of those disciplinary actions was for sexual misconduct. Greer went on to sleep with one of his VA patients.

In 2004, a VA clinic in Lafayette, Louisiana, hired a psychologist with several felony convictions. He was fired earlier this year after complaints racked up and an internal investigation deemed him a “direct threat to others.” A VA hospital in Jackson, Mississippi, hired ophthalmologist Daniel K. Kim, despite disciplinary actions against him by Georgia’s medical board. In 2006, a surgery by Dr. Kim left a WWII veteran blinded. In 2012, Kim allegedly implanted the wrong lens in another patient’s eye.

VA patients who spoke with the paper said that they deserved better.

“Here the veterans—they went and served their country—and they’re messed up and everything,” said Michael Green, who is awaiting a malpractice payment from Dr. Schneider for an allegedly botched spine surgery. “And then turn that guy loose on them—that’s what doesn’t make sense.”

See, this is why I haven't used the VA in years, despite having the right to do so. Once I was done with rehab, the "care" I received there was so abysmal it was literally not worth the hassles involved. It's a despicable fact of life for all veterans, let alone the disabled ones such as myself.

Doctors who allegedly maim, paralyze, and kill can get work all over the place, not just at the VA. Part of this is due to shoddy record-keeping, lax state standards, and toothless or uconcerned oversight boards -- see The Dr. Christopher Duntcsh horror story for just one example. However, if you go too far and try to oust all doctors with some poor outcomes on their record, you will end up causing surgeons to refuse even to try to act on potentially-treatable cases because the patient is too high-risk and likely to decrease their outcomes measures. If you had a 0% chance of survival without surgery and a 5% chance of complete recovery with a high risk of morbidity and mortality with surgery, do you want the option for surgery or do you want all of the surgeons to refuse to take the case because they're afraid of their outcomes measures?

I've worked in a VA - and I have seen caregivers there that "used up their chances elsewhere". That said, there are others who definitely "fight the system" to make sure the vets actually get good care.

Is the VA a 100% direct services provider? Might be a good idea to transition from providing direct services to running as a health insurance entity. You have monolithic market power to keep costs under control, and maybe can piggyback on Medicaid accreditation, and leave it to private entities, heavily invested in avoiding putative penalties, to vet the doctors. Since whatever incentives are in place for the VA to do that don't appear to be working.

When I was in the USAF I went to the clinic at Randolph AFB for an issue. The doctor, Wiswell was her last name, told me in conversation that she had lost her medical license in Texas and could only work on the military base. Seems that since the base was federal property state laws were trumped by federal laws, specifically licensing in Texas. Thus the military now had her for a doctor on base. I asked for another doctor and was denied. Went back to work for a couple of hours and went back to the clinic and was able to see the next available doctor.

The VA is just echoing what the rest of the military is doing regarding healthcare for the military. Using bottom feeders.

The things that we do to those that actually SERVE their country is deplorable. The only way I see change happening is requiring congress to use the VA for all of their medical services; watch how fast it would get fixed if Congress had to use the VA.

Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry"

"Conclusions

There is substantial variation in the likelihood of malpractice suits and the size of indemnity payments across specialties. The cumulative risk of facing a malpractice claim is high in all specialties, although most claims do not lead to payments to plaintiffs. (Funded by the RAND Institute for Civil Justice and the National Institute on Aging.)"

"Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry"

If you are surgeon there is a %99 you will face at least one malpractice complaint in your career.

There's a difference between simply having a malpractice claim on one's record and having a string of obvious malfeasance like the cases in question.

The medical licensing system in the USA is a case of the patients running the asylum.

There is every incentive to keep a "doctor" practicing and none to decertify where appropriate.

And the doctors in the linked story didn't just have *a* malpractice claim.

Quote:

In 2014, the Wyoming Board of Medicine revoked Schneider’s license following a wrongful death suit filed by the family of one of his former patients. In that case from 2011... Still, Schneider held a medical license from Montana and continued to practice. Later in 2014...

Just an example of what this takes. And the doctor STILL practiced, and was hired by the VA.

I don't want to stomp on the VA. But we aren't merely talking about the occasional malpractice claim with doctors such as those highlighted herein.

When I was in the USAF I went to the clinic at Randolph AFB for an issue. The doctor, Wiswell was her last name, told me in conversation that she had lost her medical license in Texas and could only work on the military base. Seems that since the base was federal property state laws were trumped by federal laws, specifically licensing in Texas. Thus the military now had her for a doctor on base. I asked for another doctor and was denied. Went back to work for a couple of hours and went back to the clinic and was able to see the next available doctor.

The VA is just echoing what the rest of the military is doing regarding healthcare for the military. Using bottom feeders.

There are lots of good doc (and nurses and techs and other clinical staff) but there are providers that can't make it in the real world. The statement in TFA concerning individual's malpractice policies makes little sense. MOST providers don't have their 'own' malpractice policies- there are very few docs in individual private practice these days. Most malpractice policies are paid by the professional corporation / clinic / hospital that employs the doc.

The government is a special case. Through the Federal Torts Claims act, the Feds don't have to allow a malpractice suite to proceed. That said, especially for the VA, most of the docs carry 'regular' malpractice coverage because VA patients can be covered in part by other insurers who insist on having coverage.

It's rare that an insurer would deny coverage but they can certainly bump the premium.

See, this is why I haven't used the VA in years, despite having the right to do so.

Yep. I have a good friend who's a disabled Army veteran. He even works at the VA even though the pay is lousy because he likes caring for other veterans. But he gets most of his medical care through an outside insurance plan, because he just doesn't trust most of the VA doctors to handle anything serious, both due to incompetence and to the VA being too cheap to pay for cutting edge drugs and treatment.

I did my residency rotations at the VA and can confirm most of what this story implies. The place is usually run by physicians who have been sued at other places. I have first handed seen patients being treated with the incorrect therapies.

When I tried to point out the mistakes on a particular veterans care, I was called into the office of the local chief medical officer and told to modify my notes in the electronic records (to make them "not look bad"). They was an implied threat that if this happens again, I will not be able to complete my residency and that the "feds will have my file"

Being an immigrant physician, I did what was asked and kept under the radar.

However, I can also attest that there were excellent physicians and educators who strived to make a change in the life of veterans. These physicians are far and few in-between (usually located in larger tertiary care VA hospitals). For the most part unfortunately, the system always wins.

I've worked in a VA - and I have seen caregivers there that "used up their chances elsewhere". That said, there are others who definitely "fight the system" to make sure the vets actually get good care.

It's a shame, but many times, the system wins.

Being dependent as I am on the VA for all my medical care, I've seen both the good and the bad.

If I could sue my previous primary care physician for incompetence, I would.

I've had exactly one doctor who was "good". I've had one I fired (and filed a complaint against). The rest are mostly rubber-stampers who "do no harm", but don't really rise above the background noise in delivering care. Most people can remember the good ones, and the bad ones (I do), but I'll be damned if I can even remember the name of the one I have NOW (who's neither a good one nor a bad one, but he's the head of the primary care division of the clinic I usually go to and I got him after I fired my previous one).

The point is, that's a pretty shitty average overall on the quality of physicians. I've had about 6 or 7 of them in the last 13 years. Before then, I hadn't considered the VA as an option, and mostly relied on community clinics, who actually delivered better care overall.

I also tend to think (perhaps wrongly), that I'm uniquely qualified to assess the quality of care I get. After high school, I was a Corpsman, working ward duty, then ER and then ambulances/outpatient clinic. Once I was discharged, I worked in a variety of positions in hospitals (mostly intensive care environments) for a cumulative total of 20 years in the medical field before I decided I needed a change and got into IT. So I've seen this from both sides, and think I have a bit more of a clue as to what's "right", and what's not, in the medical field than say, an infantry cook who runs a restaurant as a civilian.

It's industrial health care, and you are a cog. I almost lost my leg thanks to their incompetence (both the RN and the physician were at fault) all thanks to the industrialized "put a pill on it and kick them out" approach to health care they get. The system itself lends itself to being abused and having people fall through the health care cracks. The entire set-up has very specific guidelines that require huge amounts of i dotting and t crossing with more pigeon-holing than any other service industry I've ever encountered. There is very little latitude for independent action, the formularies (what drugs are available) are very limited, and in order to get a vital surgery it can take eight to ten months. The wards are hellishly loud, making "recovery" something you want to do on a bench in the cold in a park somewhere (it's more comfortable in the park).

Sadly, this revelation that incompetent physicians can find refuge at the VA surprises me absolutely not at all. It does, however, explain my experiences there.

Rather than building out a whole secondary medical infrastructure, it would make more sense to just do away with the VA hospital system entirely and buy vets standard health insurance policies with the discounts that would come from their sizable group rate. Even if we subsidized their deductibles and co-pays it would probably be cheaper, and provide much better health care.

The VA is an example of government RUN healthcare. Medicare is an example of SINGLE PAYOR healthcare.

I have no doubt about the reality of the abuses reported by USA Today. On the other hand, I suspect that one should not jump to conclusions (as a few commenters seem to do when they blame the current government-run system and suggest moving toward a mere insurance plan). I question whether the private sector is any better, on average. I note several reports that claim that VA health care has been found to be superior to non-VA health care.

The VA is an example of government RUN healthcare. Medicare is an example of SINGLE PAYOR healthcare.

Indeed. In fact, expanding the Medicare system would be the simplest, most efficient way to provide meaningful national health care. And it would benefit the Medicare system by expanding its pool of users to include younger, healthier subscribers.

I wouldn't want to work for the VA. They send dental patients my way all the time with a list of what they want done, I send them back a list of what actually needs to be done, they reject it and try to find somebody else willing to perform bad dentistry. I really feel bad for the dentists that have that as their first job out of school and think treating people at a predetermined dollar amount is how you should be treating people. It really doesn't surprise me that they are so hard up for talent that people like this are able to get work there.

Sadly "support our troops" is a yellow ribbon for morons to stick to their LTV (Light truck vehicle) and out themselves. Once the soldiers come back it is "Not with my tax dollars!!!!". Hell Bush ran on supporting the troops and first thing he did was cut their benefits.

If you are worried about incompetent doctors killing vets, don't worry so much, many will die of old age waiting to see any doctor at all.

The VA is an example of government RUN healthcare. Medicare is an example of SINGLE PAYOR healthcare.

Indeed. In fact, expanding the Medicare system would be the simplest, most efficient way to provide meaningful national health care. And it would benefit the Medicare system by expanding its pool of users to include younger, healthier subscribers.

The issue of course is moving from the current system to a more efficient system by throwing enough bones to the current players that they don't block every step of the way. Very difficult. Have you seen the P & L's of the major pharmaceutical companies lately? That's a lot of lobbying dollars.

Having been a patient in the VA system for about five years now, and having worked as a contractor doing IT work for the VA/DoD, I want to confirm others' sentiments.

The VA sucks. If one hasn't experienced the joke that is the VA first hand, then no amount of words can really convey how broken the system is. Having suffered through it as a veteran, and having seen it from the inside as a contractor, I guarantee the problem is worse than anyone without such knowledge realizes.

On the plus side, there are many genuinely caring and wonderful people working for the VA. However, their hands are often tied by a system that just doesn't care, and never will until ALL MEMBERS OF THE GOVERNMENT must use the VA healthcare system. Or do away with the VA and give all vets and politicians Medicaid. Might fix two broken systems with one broad act.

Sadly "support our troops" is a yellow ribbon for morons to stick to their LTV (Light truck vehicle) and out themselves. Once the soldiers come back it is "Not with my tax dollars!!!!". Hell Bush ran on supporting the troops and first thing he did was cut their benefits.

If you are worried about incompetent doctors killing vets, don't worry so much, many will die of old age waiting to see any doctor at all.

Its an American tradition dating back to the Revolutionary war. Wasn't it McArthur that sent the (then) current troops out against vets marching for their (perceived) rights in the 30's. We are really slow learners.

Single payer healthcare in action. If the government can't get the VA right, why do people think giving the rest of the healthcare industry to the government is a good idea?

Oh, just F*** Right Off! In countries where single payer healthcare is in effect, the outcomes are CLEARLY far better and far cheaper.

In the 'States, you get fewer hospital beds, fewer doctors, and twice the cost! Mind you, you also die earlier, so that's a bonus, I guess.

That’s a little harsh on someone for pointing out the fact that the one example (in the US) of government run healthcare sucks.

I agree with your assessment of single payer healthcare IN OTHER COUNTRIES.

The problem, as someone mentioned above, is that the implementation in the US quickly devolves into fixed cost HMO style bean counting instead of allowing medical professionals to do their job and provide the correct and best care.

Single payer healthcare in action. If the government can't get the VA right, why do people think giving the rest of the healthcare industry to the government is a good idea?

Oh, just F*** Right Off! In countries where single payer healthcare is in effect, the outcomes are CLEARLY far better and far cheaper.

In the 'States, you get fewer hospital beds, fewer doctors, and twice the cost! Mind you, you also die earlier, so that's a bonus, I guess.

That’s a little harsh on someone for pointing out the fact that the one example (in the US) of government run healthcare sucks.

I agree with your assessment of single payer healthcare IN OTHER COUNTRIES.

The problem, as someone mentioned above, is that the implementation in the US quickly devolves into fixed cost HMO style bean counting instead of allowing medical professionals to do their job and provide the correct and best care.

What is your definition of correct and best care? Seems to me every time people bemoan that doctors can't do their job. It's generally because insurance companies or Medicaid/Medicare prevent them from ordering whatever the fuck they want regardless of efficiency in care or benefit to the patient.

You're naive if you think other countries single payer included just let doctors do what they want with no oversight (bean counting) of the tests and procedures ordered.

There is a gross incentive for providers ordering more tests regardless of actual need which necessitates someone saying no. Especially in a fee-for-service model that the US healthcare model follows.

Single payer healthcare in action. If the government can't get the VA right, why do people think giving the rest of the healthcare industry to the government is a good idea?

Medicare works pretty well. You don't employ the doctors directly, you just pay them (and verify that they are doing a reasonable job).

Health care is a very touchy subject. Everyone wants the best but only the top few percent of the population can afford it without insurance. The insurance companies want to make a profit so they charge high rates and deny everything they can. I have a couple of horror stories about when my wife had lung cancer.

I think I would prefer the government to pay the doctors - they aren't trying to make a profit by refusing to pay the cost of people's health issues.

Somehow other countries manage to get better outcomes for their healthcare dollars despite "beancounters" deciding what is the best therapy. Of course you can't pay for every conceivable procedure for every conceivable patient. But continuing on the path we are on will certainly bankrupt this country.